Organization
INTERMOUNTAIN NEUROVISION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN TATOMIR (C.E.O.)
(208) 866-7399
Entity
Organization
Contact information
Practice address
30251 GOLDEN LANTERN, SUITE E 577, LAGUNA NIGUEL, CA 92677-5993
(877) 446-4945
Mailing address
30251 GOLDEN LANTERN, SUITE E 577, LAGUNA NIGUEL, CA 92677-5993
(877) 446-4945
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/01/2014
Last updated
09/05/2016
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